Variation in aerosol generation by surgical modality during oropharyngeal and laryngeal surgery.

Objectives: The objectives were to determine the surgical modality with the lowest aerosol and droplets generated by commonly used modalities in oropharyngeal and laryngeal surgery. Methods: A simulation of oropharyngeal and laryngeal surgery was set up using fresh sheep heads. Four common surgical modalities were utilized: cold steel, electrocautery, coblation, and microdebrider. The resultant aerosol generated was evaluated using two measurement modalities at two key positions in the theater. (1) DustTrak Pro Aerosol Monitor was used to measure the concentration of particles. (2) Fluorescein dye coated on the oropharynx and larynx, and the resultant scatter on paper. Results: Electrocautery and coblation produced statistically significant increases in the concentration of aerosols (p < .001). Microdebrider and cold steel instrumentation produced the least aerosols. No measurable fluorescein droplets were noted for all four modalities. Conclusion: Electrocautery and coblation produced higher concentrations of aerosols. Mitigation factors should be considered with instruments with increased aerosolization. These modalities show low droplet-related infection risk.

Are HIV-positive presumptive tuberculosis patients without tuberculosis getting the care they need in Zimbabwe?

SETTING: Emakhandeni Clinic provides decentralised and integrated tuberculosis (TB) and human immunodeficiency virus (HIV) care in Bulawayo, Zimbabwe. OBJECTIVES: To compare HIV care for presumptive TB patients with and without TB registered in 2013. DESIGN: Retrospective cohort study using routine programme data. RESULTS: Of 422 registered presumptive TB patients, 26% were already known to be HIV-positive. Among the remaining 315 patients, 255 (81%) were tested for HIV, of whom 190 (75%) tested HIV-positive. Of these, 26% were diagnosed with TB and 71% without TB (3% had no TB result recorded). For the 134 patients without TB, antiretroviral treatment (ART) eligibility data were recorded for 42 (31%); 95% of these were ART eligible. Initiation of cotrimoxazole preventive therapy (CPT) and ART was recorded for respectively 88% and 90% of HIV-positive patients with TB compared with respectively 40% and 38% of HIV-positive patients without TB (P < 0.001). CONCLUSION: Presumptive TB patients without TB had a high HIV positivity rate and, for those with available data, most were ART eligible. Unlike HIV-positive patients diagnosed with TB, CPT and ART uptake for these patients was poor. A 'test and treat' approach and better service linkages could be life-saving for these patients, especially in southern Africa, where there are high burdens of HIV and TB.

Contexte : Le centre de santé Emakhandeni, qui offre une prise en charge de la tuberculose (TB) et du virus de l'immunodéficience humaine (VIH) décentralisée et intégrée à Bulawayo, Zimbabwe.Objectifs : Comparer la prise en charge du VIH pour les patients présumés tuberculeux, avec et sans TB, enregistrés en 2013.Schéma : Etude rétrospective de cohorte basée sur les données de routine du programme.Résultats: Sur 422 patients présumés tuberculeux enregistrés, 26% étaient connus comme VIH positifs. Parmi les 315 patients restants, 255 (81%) ont eu un test VIH, dont 190 (75%) se sont avérés positifs. Parmi eux, 26% ont eu un diagnostic de TB et 71% n'ont pas été confirmés tuberculeux (les 3% restants n'ont eu aucun résultat de TB enregistré). Pour les 134 patients sans TB, les données d'éligibilité au traitement antirétroviral (ART) ont été notées chez 42 (31%) patients et 95% ont été éligibles à l'ART. La mise en œuvre du traitement préventif par cotrimoxazole (CPT) et l'ART a été notée pour respectivement 88% et 90% des patients VIH positifs avec TB, comparés à respectivement 40% et 38% des patients VIH positifs sans TB (P < 0,001).Conclusion : Les patients présumés TB mais non confirmés avaient un taux élevé de positivité au VIH et pour ceux dont les données étaient disponibles, la majorité était éligible à l'ART. Par contre, pour les patients VIH positifs sans une TB confirmée, le taux de mise en œuvre du traitement préventif par CPT et de l'ART a été médiocre. Une approche « tester et traiter ¼ et de meilleurs liens entre les services pourraient sauver la vie de ces patients, surtout en Afrique australe où les taux de VIH et de TB sont très élevés.

Marco de referencia: El consultorio Emakhandeni ofrece atención descentralizada e integrada de la tuberculosis (TB) y la infección por el virus de la inmunodeficiencia humana (VIH) en Bulawayo, Zimbabue.Objetivo: Comparar el servicio de atención de la infección por el VIH en los pacientes registrados con presunción clínica de TB cuyo diagnóstico se confirmó o se infirmó en el 2013.Método: Fue este un estudio retrospectivo de cohortes a partir de los datos corrientes del programa.Resultados: De los 422 pacientes registrados con presunción clínica de TB, el 26% contaba ya con una serología positiva frente al VIH. De los 315 pacientes restantes, en 255 se practicó la serología (81%) y 190 obtuvieron un resultado positivo (75%). De estos pacientes se confirmó el diagnóstico de TB en el 26% y se infirmó en el 71% (en el 3% no se registró ningún resultado sobre la TB). De los 134 pacientes sin TB, se consignaron datos sobre los criterios de inclusión en el tratamiento antirretrovírico (ART) en 42 casos (31%) y el 95% cumplía con estos criterios. En los pacientes seropositivos frente al VIH con TB se registró el comienzo del tratamiento preventivo con cotrimoxazol (CPT) en el 88% y del ART en el 90%, en comparación con el 40% y el 38%, respectivamente, en los pacientes seropositivos sin diagnóstico de TB (P < 0,001).Conclusión: Los pacientes con presunción clínica de TB en quienes se infirmó el diagnóstico presentaron una alta tasa de seropositividad frente al VIH y en los pacientes con datos registrados, la mayoría cumplía con los criterios de iniciación del ART. En estos pacientes la aceptación del CPT y el ART fue baja, a diferencia de los pacientes seropositivos con diagnóstico de TB. Una estrategia de 'prueba diagnóstica y tratamiento' y una mayor vinculación de los servicios podrían contribuir a salvar vidas en este grupo de pacientes, sobre todo en el sur de África, donde existen altas tasas de morbilidad por la infección por el VIH y la TB.

The endotoxin binding and antioxidative properties of ceramic granules.

OBJECTIVE: To investigate the possible antimicrobial activities and the detoxification (endotoxin binding and free radical scavenging) properties of Cerdak. METHOD: In order to measure the antimicrobial activity of Cerdak, microorganisms were separately inoculated into nutrient agar in the presence of Cerdak, and growth was observed over 48 hours. Cerdak was incubated with 4000EU/ml endotoxin, and the residual endotoxin was determined over 24 hours. The decrease in the colour of ABTS and DPPH (inorganic free radicals) in the presence of Cerdak was colourimetrically monitored as a measure of Cerdax's free radical scavenging ability. DNA was exposed to hydrogen peroxide and ultraviolet irradiation in the presence and absence of Cerdak. The DNA strand break was then observed through electrophoresis. RESULTS: While Cerdak had little or no antibacterial activities, it demonstrated a high water and endotoxin-binding capacity. It also protected DNA from damage by reactive oxygen species. CONCLUSION: The detoxification properties of Cerdak could contribute to its healing abilities.

Characterisation of particulate matter emissions from the Zimbabwe Mining and Smelting Company (ZIMASCO) Kwekwe Division (Zimbabwe): a ferrochrome smelter.

Particulate matter emissions from stack number 2 of a major ferrochrome smelter, Zimbabwe Mining and Smelting Company (ZIMASCO) were characterized and the rates at which the elements Cr, Fe, Cu and Zn and total ferrochrome dust are emitted into the atmosphere were determined. The extent of soil contamination by the dust deposited around the smelter in the generally prevailing southeasterly wind direction around the smelter was carried out. The highest concentrations of Cr and Fe occurred in the fine particulates of sizes less than 59 microm whilst that of Cu and Zn occurred in the coarse particulates of size range 70-100 microm. The emission rates from stack 2 were; total ferrochrome particulates 62.17 kg h(-1), Cr 6.217 kg h(-1), Fe 2.423 kg h(-1), Zn 42 mg h(-1) and 6 mg h(-1) for Cu. Particulate matter was emitted at a rate of 289 mg m(-3) from stack number 2. This value exceeds the legal limit of 200 mg m(-3). Chromium and iron are the metals in the largest amounts. The particles that constitute the largest proportion of the dust were in the range of 58-107.5 microm. This is a characteristic feature of the particulate matter emissions from ZIMASCO. Soils in the downwind direction from the smelter were polluted with Cr up to a distance of about 700 m outward from the perimeter of the boundary of the smelter.

Indoor woodsmoke pollution causing lower respiratory disease in children.

Suggested aetiological factors were evaluated in 244 consecutive children presenting with lower respiratory disease at Marondera Hospital, Zimbabwe. Data obtained from these children were compared with information obtained from 500 children seen at the local well baby clinic. There were no differences in the prevalence of malnutrition, breast feeding, overcrowding, poor housing conditions and poverty in these two groups of children. A significant association was identified between lower respiratory disease and exposure to atmospheric woodsmoke pollution in young children. Air sampling within the kitchens of 40 children revealed levels of atmospheric pollution far in excess of the WHO recommended exposure limit. Elevated carboxyhaemoglobin concentrations confirmed childhood smoke inhalation. We suggest that in many Third World communities a chemical pneumonitis resulting from the inhalation of noxious constituents of woodsmoke predisposes to lower respiratory disease in children.